Question

13 year-old right-hand dominant following assault with blunt object. What’s the diagnosis?

Answer

Monteggia Fracture

• Ulnar fracture with dislocation of proximal radioulnar joint (often subtle); do not confuse with Galeazzi fracture (radial-shaft fracture with distal radioulnar dislocation)
• Interosseous membrane (between radius and ulna) transmits forces to radioulnar joints and causes associated dislocations.
• Secondary to fall on outstretched hand with arm in hyper-pronation or with direct trauma to forearm as in defensive wounds (e.g., nightstick injury).Suspected forearm fractures should include Xray of the wrist, forearm, and elbow
• Children may be treated with closed reduction and immobilization; adults usually require open reduction and internal fixation. Radial head dislocations should be reduced within 6-8 hours because of associated articular damage and nerve injury.
• Radial, ulnar, and median nerve neuropraxias (motor / sensory deficits) may complicate injury.

References

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